NPI | 1902856305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 17230) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 17230) |
Enumeration Date | 2006-05-10 |
Last Update Date | 2011-06-22 |